Prevalence, types, maternal and perinatal outcomes of cardiac disease in pregnancy at a tertiary Hospital in the Eastern Cape, South Africa.

Background: Cardiac disease is a leading non-obstetric cause of maternal morbidity and mortality, particularly in low- and middle-income countries. Methods: Retrospective cross-sectional review of all deliveries from 01 January 2020 to 31 December 2022. Echocardiography-confirmed cardiac disease cases were identified. Data included demographics, lesion type and/or severity (New York Heart Association [NYHA]), timing of diagnosis, delivery characteristics and outcomes. Associations were examined using χ Results: Among 11 728 deliveries, 182 had cardiac disease (prevalence 1.6%, 95% CI: 1.34-1.80). Median age was 26 years (IQR 22-31); 50.6% presented with NYHA III-IV. Rheumatic heart disease (RHD) predominated (61.5%), mainly mitral stenosis (43.8%) and mitral regurgitation (38.3%). Cardiomyopathy accounted for 31.3%; peripartum cardiomyopathy (PPCM) comprised 78.9% of cardiomyopathies, most diagnosed postpartum (64.9%) and frequently with Left Ventricular Ejection Fraction (LVEF) < 45%. Preterm birth occurred in 46.9% of pregnancies, particularly with RHD-MS (mean gestational age (GA) 33.0 ± 6.0 weeks; Conclusion: Rheumatic heart disease and PPCM were the dominant lesions and major drivers of severe morbidity and mortality. Contribution: The high burden of late presentation and severe functional limitation underscores the need for earlier detection, systematised cardio-obstetric care and strengthened primary prevention of RHD.